High Fever, Clouded Eyes, and Rambling Speech? Doctor Zhang Xichun’s Two-Dose Rehmannia Rescue of a Dying Farmer
Patient search terms: persistent high fever / fever with rambling speech / eyes that can no longer see / hands fumbling at the edge of the bed / body thrashing about / loose stools
Medical terms for this condition: febrile disease (wen bing) with yin deficiency · kidney yin on the verge of exhaustion · yin deficiency preventing the sweat from coming out
Opening: a “death sentence” taken on by a 26-year-old
The case we are looking at today — febrile disease with yin deficiency — was treated by Doctor Zhang Xichun when he was 26 years old, practicing medicine in his hometown. You heard that right: twenty-six. What level of skill could a young man already have reached back then? The patient had become so ill that he could not see, his hands fumbled along the edge of the bed, and he spoke nonsense. Two famous local doctors had treated him for more than ten days with no effect, and the family was preparing for the worst — and then Doctor Zhang Xichun saved him with two doses of medicine.
💬 Note from Doctor Luo: Why do I keep returning to febrile disease (wen bing)? Because the epidemic period is not completely over, and people need more knowledge about treating exterior-contracted illness. With this knowledge we know how to protect ourselves. So today we continue with exterior-contracted disease — and in this case, Doctor Zhang Xichun’s skill at 26 was already remarkably high.
Who was the patient? A disease earned by hurrying under the blazing sun at harvest time
The patient was named Gao Chengxuan, 25 years old, from a neighboring village — one year younger than Doctor Zhang Xichun himself, a farmer by trade. How did he fall ill? In early midsummer, when the wheat harvest was about to begin — the busiest season of the farming year. He had gone out on business far from home, and was hurrying back in time for the harvest. Walking a long distance under the blazing sun, exhausted and strained, he came down with febrile disease.
💬 Note from Doctor Luo: Anyone who has been following this series on exterior-contracted illness knows that at this point we need to analyze internal and external causes. The external cause? The blazing sun. The sun beat down mercilessly, and a man walking a long way sweats profusely — more sweat, more loss of fluids (jin ye) — so he was injured by dry, scorching heat. On top of that he was utterly exhausted — rushing home, his upright qi (zheng qi) was insufficient — that is internal damage. External and internal causes combined, and the febrile disease arrived.
How sick was he? Blind, picking at the bedclothes, speaking nonsense
When Doctor Zhang Xichun arrived and looked at this patient, every single symptom was alarming:
His eyes were clear and empty, and he could no longer see (liang mu qing bai, jing wu suo jian) — his eyes had gone sightless. Both hands fumbled at the edge of his clothes and his bed (liang shou xun yi mo chuang) — constantly feeling along the hems and the bedside, as though trying to thread a needle in mid-air. His body moved restlessly without stopping; he was delirious, incoherent, and completely unconscious — nothing but nonsense, and no answer when asked anything. Asked further, he had earlier had uncontrolled slippery stools (da bian hua xie), and although that had stopped, he still passed loose stools once or twice a day.
💬 Note from Doctor Luo: What does “clear and empty eyes” mean? A healthy person’s pupils are black — clear, bright, and spirited. When someone is about to die, the spirit suddenly drains away: the black of the eye turns dull, the whole eye looks pale and hazy — this is what the classics call loss of spirit (shi shen). And “picking at the bedclothes” is another sign that the old books reserve for the dying: the patient’s hands keep stroking the edge of the garment — not the middle, just the edge, a tiny strip. I have watched critically ill patients many times, and this is exactly what they do. Once these two signs appear, anyone who knows the classics understands: this person is nearly gone.
Later this case was collected by He Lianchen into his anthology of famous physicians’ cases. He Lianchen’s verdict: this really was a death sentence. A patient this far gone should, by all logic, have been untreatable — yet Doctor Zhang Xichun brought him back, and He Lianchen admitted he found it hard to believe.
The pulse and tongue: floating but weak, the chi pulses gone at a touch
Now the pulse: floating but without strength (mai fu er wu li) — a floating pulse means the pathogen is still at the exterior. The cun pulse on the right was floating especially strongly — the cun position corresponds to the lung. The two chi pulses disappeared the moment they were pressed (liang chi mai an zhi ji wu) — the two chi positions represent the kidneys, and to find nothing there means the kidney qi is exhausted. The pulse raced at 120 beats per minute. The tongue coating was thin and yellow, dry in the center and slightly black.
💬 Note from Doctor Luo: Doctor Zhang Xichun rarely described tongue signs — the fact that he described this one so carefully shows how deeply it impressed him. A thin yellow coating, dry and slightly black in the middle — this tells you the heat inside was extraordinarily severe. And a pulse at 120 beats per minute with chi pulses that vanish under the finger — the kidney qi was failing at its very root.
Doctor Zhang’s verdict: kidney yin exhausted, liver wind stirring — yet one thread of life remained
The two physicians — the patient’s uncle Gao Luxuan and his cousin Mao Xiange — were both famous local doctors (both later became close friends of Doctor Zhang Xichun), and both were skilled in treating febrile disease. After ten days without success, they called in Doctor Zhang. They asked him: what do you make of this? Can he be saved?
Doctor Zhang’s answer was decisive: “When the eyes are clear and empty, without fire, and yet see nothing, the kidney yin is on the verge of exhaustion (shen yin jiang jie); when both hands move restlessly without stopping, the liver wind has stirred (gan feng yi dong).” By this point the condition was dangerous in the extreme. But — there was still one thread of life.
The two famous doctors looked at each other. Gao Luxuan spoke with total honesty: “I have practiced medicine for over twenty years and I am reasonably well known locally. I have met this kind of case who knows how many times, and I have never brought a single one back — eyes gone blind, picking at the bedclothes, body thrashing, talking nonsense: every such patient who came to me died. But today you, a handsome young man of twenty-six, are willing to take the whole responsibility on your shoulders and declare him savable — excellent! If you truly bring him back, this boy ought to be renamed ‘Reborn’ (zai sheng), to commemorate the fact that you gave him life a second time! Now hurry — write the prescription.”
💬 Note from Doctor Luo: Where was the thread of life? The pulse was still floating. A floating pulse means the pathogen was still in the taiyang stage, still at the exterior — it had not penetrated deep inside. Most of his problems came from insufficient upright qi. Since the pathogen had not gone deep, there was still a chance to push it back out. That is the most critical stroke in the whole assessment: he looked moribund, but in fact the pathogen had not moved inward — the body was simply too weak to drive it out.
The key question: why would the sweat not come?
Doctor Zhang Xichun also noticed: the right cun pulse floated with unusual force — corresponding to the lung — which told him the man was on the verge of sweating: a good sweat should have released the pathogen and resolved everything. So why did he seem “about to sweat” and yet never sweat — why no perspiration at all?
💬 Note from Doctor Luo: Doctor Zhang Xichun used a wonderful analogy. The sweat on a human body is like rain between heaven and earth: for rain to fall, yin and yang must come together and overflow — in the sky you need cold air, and on the ground you need damp vapor rising, and only then does the rain fall. The human body is the same: yin and yang unite and sweat appears. In this case, though, both chi pulses were extremely weak — the kidney yin was insufficient above all. The yang qi wanted to produce sweat, but the yin would not cooperate — without the “water system,” how could the rain fall? This man had walked a long way under a blazing sun; his body fluids were severely depleted, and he was probably of a yin-deficient constitution to begin with. The more he sweated, the fewer fluids remained; then a cool wind blew on him, and illness struck. The exterior had been attacked by cold, so sweating was the right response — but with no fluids inside, the sweat could never come, and the pathogen at the exterior could not be released.
What did Doctor Zhang do? His strategy was eight characters: greatly nourish the true yin, so that the yin can answer the yang (da zi zhen yin, zi yin yi ying qi yang) — replenish the yin fully, and when the yang wants to sweat there will be fluid for it to work with; the sweat comes out, and the disease is cured. Had he instead forced the sweat with strong diaphoretics at this point, the upright qi would certainly have collapsed and the man would have died. So he did not treat the exterior at all — he simply nourished the yin.
Breaking down the prescription: not a single pathogen-expelling herb — pure yin nourishment and essence tonics
The formula he wrote was deliberate from top to bottom:
Shu di huang (prepared rehmannia), 2 liang (60 g), leading the formula — Shu Huai di huang, the prepared rehmannia from Wen County, Jiaozuo, Henan, traditionally made by steaming and sun-drying nine times. What was it for? To greatly supplement the essence of the liver and kidneys — above all the kidney essence, because kidney essence is the source of kidney yin, the most fundamental thing there is.
Huai shan yao (Huai yam), 1 liang (30 g) — dried yam slices from Wen County, Jiaozuo, Henan. It greatly strengthens the spleen and stomach, nourishes the earth so that fluids are produced, builds up the lung qi, and supports the upright qi.
Xuan shen (figwort root), 1 liang (30 g) — nourishes yin and supplements fluids, while also clearing heat and resolving toxins. It has one special action besides: it draws the yin fluids of the kidneys upward, which is why it is so often used for swollen, painful throats.
Gou qi (wolfberry), 1 liang (30 g) — supplements the essence of the liver and kidneys. Gan cao (licorice), 3 qian (9 g) — harmonizes all the herbs and helps resolve toxins. True e-jiao (donkey-hide gelatin), 4 qian (12 g) — nourishes the blood and the yin.
💬 Note from Doctor Luo: Look at this formula: it focuses entirely on supporting the upright — not a single herb for expelling the pathogen, only yin-nourishing, essence-tonifying medicines, and in large doses. This was a concentrated effort to replenish the true yin. Doses like this — prepared rehmannia 2 liang, Huai yam 1 liang, figwort root 1 liang, wolfberry 1 liang — were the common working doses in the books of Zhang Jingyue (Zhang Jiebin) and Chen Shiduo. The medicine was decocted into one large bowl, strained, and the donkey-hide gelatin stirred in to dissolve; it was then drunk warm, in several portions.
Two doses in a single day: by candlelight, sweat poured through his body and the illness was gone
The medicine was ready at ten in the morning; by two in the afternoon he had slowly finished it. After drinking it, the patient was clearly much calmer than before, and when the pulse was taken again it had noticeably improved. Seeing it was working, Doctor Zhang Xichun had another dose of the same formula prepared and continued having him drink it slowly.
💬 Note from Doctor Luo: That evening, at candle-lighting time (bing zhu shi fen) — the moment when the lamps were first lit — the patient responded: sweat poured through his entire body (hun shen de tou han), a great drenching sweat, all at once! And then the illness dissolved completely (qi bing huo ran yu yi) — he was cured. Think about it: two celebrated local physicians had worked together for more than ten days on a dying man without success. Doctor Zhang Xichun arrived, wrote a prescription, and the patient finished two doses within a single day — and was well. What does that tell you? For a 26-year-old to practice medicine at this level is truly remarkable.
He Lianchen’s doubt, and Doctor Zhang’s confidence
Later, He Lianchen collected this case into his Classified Anthology of Famous Physicians’ Cases, with considerable skepticism: according to what was written, this was plainly an incurable case — and he cured it in a dose or two? Genuine or not? When Doctor Zhang Xichun heard this, he said: precisely because he doubted it, I have written down every detail of that time — what is there to doubt?
💬 Note from Doctor Luo: How detailed was Doctor Zhang Xichun’s account? He even recorded the patient’s son’s name. The patient’s son, Xianzhuang, grew up, studied medicine under Doctor Zhang, and later practiced in Tianjin with considerable renown; he often reminisced with his father and was endlessly grateful to Doctor Zhang. The name, whose child he was, what became of him later — all written out plainly. What room is left for doubt? And why did He Lianchen doubt it at all? There is a very interesting background here. After the rise of the Qing-dynasty warm-disease (wen bing) school, with its heat-clearing, toxin-resolving, pathogen-percolating, blood-cooling approach, physicians came to believe that prepared rehmannia was cloying and would drive the pathogen deeper — so they mocked Zhang Jingyue for “reckless tonification.” In truth, it was they who had gone astray. By the late Qing and Republican era, physicians like He Lianchen basically could not believe such a patient could be saved. The medical establishment of that time prided itself on “predicting death” (liao ren bi si): they could tell you exactly which day you would die, but they could not treat you. Doctor Zhang Xichun cured the case — which shows that the profession of his day had lost many fine traditions and instead picked up the bad habit of the Qing era: disparaging one another. In reality, every physician has his own field of strength.
Bonus story one: the three Zhangs — the three physicians who contributed the most formulas to the materia medica curriculum
Why did Doctor Zhang Xichun dare to use prepared rehmannia this way? Because the books he read as a young man — Zhang Jingyue’s Complete Works of Jingyue (Jingyue Quanshu) above all — left a deep impression. Zhang Jingyue was nicknamed “Zhang Shudi” (“Zhang the Prepared-Rehmannia Man”): in treating internal-damage disease he was especially fond of prepared rehmannia, and used it in very large doses.
💬 Note from Doctor Luo: At that time there was a Daoist lineage — physicians like Chen Shiduo and Zhang Jingyue were Daoist cultivators as well as doctors, and they passed down a tradition: use large doses of prepared rehmannia to replenish the essence of the kidneys, support the upright qi first, and then treat the disease. Sadly, this tradition was lost in later generations — by the Qing dynasty everyone was attacking Zhang Jingyue. But Zhang Jingyue’s methods surpassed the thinking of many Qing physicians; he was extremely accomplished. Do you know who the top three physicians are in terms of the number of formulas quoted in the standard TCM materia medica textbooks? First, Zhang Zhongjing; second, Zhang Jingyue; third, Zhang Xichun — all three from the Zhang family. The Zhang family’s study of Chinese medicine runs deep.
Bonus story two: the qi of heaven and earth changes every few decades — do not practice “carving your boat to find a lost sword”
At the end of this case record, Doctor Zhang Xichun added a long and extremely important reflection — on the transformations of heaven-and-earth qi (tian di zhi qi hua).
💬 Note from Doctor Luo: Doctor Zhang Xichun said that in his own experience, the qi of heaven and earth seems to change once every few decades. When he first studied medicine, he saw physicians treating cold-damage and febrile disease with purgatives — as soon as heat entered the interior and the stools became slightly bound, they used Chengqi Decoction to purge, and one purge settled it; this approach served for over twenty years. Later he read Zhang Jingyue’s books, used prepared rehmannia, and found the results superb — he recorded many cases of treating the “ruined cases” (huai zheng) of cold-damage and febrile disease with heavy doses of prepared rehmannia. After he passed forty, he felt the qi of heaven and earth shift again — patients increasingly showed insufficiency of the qi level and sinking of the great qi (da qi xia xian); he developed that theory, and in treatment he emphasized supplementing qi, adding ginseng or astragalus to even his heat-clearing formulas. After the tenth year of the Republic (1921), hyperactive-yang conditions became common, and he used White Tiger Decoction (Baihu Tang) more and more — he became especially skilled with raw gypsum (sheng shi gao). He said: in treating disease you must grasp the changes of heaven-and-earth qi and adjust with them; otherwise you are “carving your boat to mark where your sword fell into the river” — clinging to a fixed method after the situation has moved on. The ancients said sixty years make one cycle (jiazi), divided into upper, middle, and lower thirds, with a major change every twenty years. But once the cycle turns, does the old approach become useless? Not at all — methods like Zhang Jingyue’s use of prepared rehmannia are still extremely common today. Every physician’s thinking and experience matters; do not mock the doctors of the past — the qi transformations of their time really were that way. And these experiences may serve you someday. Doctor Zhang Xichun practiced for more than fifty years and watched the qi of heaven and earth change several times; he wrote it all down to tell us: respect the experience of every physician who came before you — and do not carve your boat.
Case source: Records of Chinese Medicine with Western Reference by Doctor Zhang Xichun; commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).